Systematic Review and Dose-Response Meta-Analysis on the Relationship Between Alcohol Consumption and Sickness Absence

Modelling the impacts of volumetric and minimum unit pricing for alcohol on social harms in Australia

AIMS

Alcohol pricing policies may reduce alcohol-related harms, yet little work has been done to model their effectiveness beyond health outcomes especially in Australia. We aim to estimate the impacts of four taxation and minimum unit pricing (MUP) interventions on selected social harms across sex and age subgroups in Australia.

METHODS

We used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15-42 SDs per week for men and 14-35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies.

RESULTS

All four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2-0.4 %, alcohol-related sickness presenteeism by 7-9 %, unemployment by 0.5-0.7 %, alcohol-related antisocial behaviours by 7.3-11.1 %, and crimes by 4-6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures.

CONCLUSION

Our results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.

Sickness absence and associations with sociodemographic factors, health risk behaviours, occupational stressors and adverse mental health in 40,343 UK police employees

AIMS

Police employees may experience high levels of stress due to the challenging nature of their work which can then lead to sickness absence. To date, there has been limited research on sickness absence in the police. This exploratory analysis investigated sickness absence in UK police employees.

METHODS

Secondary data analyses were conducted using data from the Airwave Health Monitoring Study (2006-2015). Past year sickness absence was self-reported and categorised as none, low (1-5 days), moderate (6-19 days) and long-term sickness absence (LTSA, 20 or more days). Descriptive statistics and multinomial logistic regressions were used to examine sickness absence and exploratory associations with sociodemographic factors, occupational stressors, health risk behaviours, and mental health outcomes, controlling for rank, gender and age.

RESULTS

From a sample of 40,343 police staff and police officers, forty-six per cent had no sickness absence within the previous year, 33% had a low amount, 13% a moderate amount and 8% were on LTSA. The groups that were more likely to take sick leave were women, non-uniformed police staff, divorced or separated, smokers and those with three or more general practitioner consultations in the past year, poorer mental health, low job satisfaction and high job strain.

CONCLUSIONS

The study highlights the groups of police employees who may be more likely to take sick leave and is unique in its use of a large cohort of police employees. The findings emphasise the importance of considering possible modifiable factors that may contribute to sickness absence in UK police forces.

Dose-response relationship between alcohol consumption and workplace absenteeism in Australia

INTRODUCTION

Workplace absenteeism is a burden in Australia. The estimated productivity losses due to alcohol were around $4.0 billion in 2017, with absenteeism driving 90% of these costs. We aim to determine the dose-response relationship between average daily alcohol consumption and heavy episodic drinking (HED) frequency and workplace absenteeism amongst Australian workers.

METHODS

We used the 2019 National Drug Strategy Household Survey of Australian employed workers aged ≥20 years to 69 years old. Respondents' average daily alcohol consumption was categorised into four: abstainers, light to moderate (1-20 g of alcohol/day), risky (>20-40 g of alcohol/day) and high-risk (>40 g of alcohol/day). HED was classified into four frequency measures (never, less than monthly, monthly, weekly). The outcome variables came from dichotomised measures of: (i) absence due to alcohol consumption; and (ii) broader sickness absence-absence due to illness or injury in the previous 3 months.

RESULTS

Risky (adjusted odds ratio 4.74 [95% CI 2.93-7.64]) and high-risk drinking (adjusted odds ratio 6.61 [95% CI 4.10-10.68]) were linked to increased odds of alcohol-related absence. Higher HED frequency was significantly associated with alcohol-related and broader sickness absenteeism. No significant associations exist between regular alcohol consumption and broader sickness absence in fully adjusted models.

DISCUSSION AND CONCLUSIONS

Findings suggest that only HED is linked to broader sickness absence. However, there is a strong dose-response association between alcohol consumption and alcohol-related absences for both consumption measures amongst Australian workers. Population-level policies that reduce alcohol consumption to moderate level and less frequent HED might address workplace absenteeism.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors

BACKGROUND

The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.

METHODS

Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).

RESULTS

A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.

CONCLUSIONS

Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Early retirement intentions among Abu Dhabi Police: investigating the role of psychosocial work factors and sickness absenteeism

BACKGROUND

Police departments are encouraged to integrate their health and safety management systems with the operational arrangements to demonstrate commitment to the improvement of working environment in the police is by the collection and analysis of occupational health data such as sickness absence and early retirement intention.

METHODS

About 760 responses to the Occupational Health and Safety Survey by the Abu Dhabi Police employees was used to analyse the early retirement intentions considering the work-related factors and sickness absence data.

RESULTS

Logistic regression results of the unadjusted model reported higher odds that lower levels of co-worker support, supervisor support, workplace support related to intentions of early retirement. Also, unfavourable perception of health management increases the odds to early retirement among the employees.

CONCLUSION

The outcome of this study provides insights into the determinants of early retirement intentions in the less explored region of middle-east, specifically in Abu Dhabi. Thorough analysis of such data will help police organisations to prioritise plans and improve the health and wellbeing of officers, in turn contributing to strengthening the fight against crime and minimizing the number of occupational injuries and premature exit from paid work.

Prevalence of and factors associated with long-term sick leave in working-age adults with osteoarthritis: a retrospective cohort study conducted in Germany

PURPOSE

Little is known about the impact of osteoarthritis on the long-term work participation of working-age adults. Therefore, the goal of this study was to investigate the prevalence of and the factors associated with long-term sick leave in people newly diagnosed with osteoarthritis from Germany.

METHODS

This retrospective cohort study included patients aged 18-65 years diagnosed with osteoarthritis for the first time (index date) in 1 of 1198 general practices in Germany between 2016 and 2019 (Disease Analyzer database, IQVIA). Patients were considered to be on long-term sick leave if they were absent from work for medical reasons for more than 42 days in the year following the index date. Independent variables included sociodemographic characteristics, type of osteoarthritis, and frequent comorbidities. The association between these variables and long-term sick leave (dependent variable) was studied using an adjusted logistic regression model.

RESULTS

This study included 51,034 patients with osteoarthritis [mean (standard deviation) age 50.8 (9.2) years; 50.9% women]. The prevalence of long-term sick leave was 36.2%. Younger age and male sex were positively and significantly associated with long-term sick leave compared with older age and female sex, respectively. There was also a strong relationship between several comorbidities (e.g., reaction to severe stress, and adjustment disorders, gastritis and duodenitis, and depression) with long-term sick leave.

CONCLUSIONS

The prevalence of long-term sick leave was high in this sample of patients newly diagnosed with osteoarthritis from Germany. In this context, interventions should be implemented to increase the long-term working participation of people with osteoarthritis.

Are workplace factors associated with employee alcohol use? The WIRUS cross-sectional study

OBJECTIVES

Sociodemographic predictors of employee alcohol use are well established in the literature, but knowledge about associations between workplace factors and alcohol use is less explored. The aim of this study was to explore whether workplace factors were associated with employee alcohol use (consumption and alcohol-related problems).

DESIGN

Cross-sectional study. Linear and binary logistic regression analyses.

SETTING

Heterogeneous sample of employees (workers and supervisors) from 22 companies across geographical locations and work divisions in Norway.

PARTICIPANTS

Employees (N=5388) responded on survey items measuring workplace factors and alcohol use.

OUTCOMES

Data on alcohol use were collected with the Alcohol Use Disorders Identification Test (AUDIT). Consumption was measured with the AUDIT-C (the first three items), and alcohol-related problems were operationalised as a sum score of 8 or higher on the full 10-item AUDIT.

RESULTS

Higher levels of alcohol consumption were associated with more liberal workplace drinking social norms (b=1.37, p<0.001), working full-time (b=0.18, p<0.001), working from holiday home (b=0.40, p<0.01), being a supervisor (b=0.25, p<0.001), having supervisors with less desired leadership qualities (b=-0.10, p<0.01), shorter working hours (b=-0.03, p<0.05), higher workplace social support (b=0.13, p<0.05) and higher income (b=0.02, p<0.001). Alcohol-related problems were associated with more liberal workplace drinking social norms (OR=3.52, p<0.001) and shorter working hours (OR=0.94, p<0.05).

CONCLUSIONS

Workplace drinking social norms were the supremely most dominant predictor of both consumption and alcohol-related problems. Results suggest that some workplace factors may play a role in explaining employee alcohol consumption, although the predictive ability of these factors was limited. This study points to the importance of drinking social norms, workplace drinking culture and leadership for understanding employee alcohol use.

Working with alcohol prevention in occupational health services: "knowing how" is more important than "knowing that" - the WIRUS OHS study

BACKGROUND

Alcohol consumption is a major public health challenge; the majority of employees consume alcohol regularly and a considerable proportion of employees can be characterized as risky drinkers in need of interventions. Occupational health services (OHS) are uniquely positioned for implementing alcohol prevention interventions targeting employees, but rarely do so. Studies have shown that lack of knowledge among OHS personnel is a barrier to alcohol prevention activity. This study aimed to explore OHS personnels' levels of theoretical and practical alcohol knowledge, and whether these two ways of knowing were differentially associated with alcohol prevention activity.

METHODS

In this cross-sectional study, survey data were collected from 322 OHS personnel in Norway in 2018 (response rate = 53.6%). The survey included variables of two ways of knowing (theoretical and practical) and three types of doing (intervention frequency, conducting individual interventions, and conducting group interventions). Data were analyzed with descriptive statistics, paired sample t-tests, bivariate correlations, and adjusted linear and logistic regression analyses.

RESULTS

OHS personnel rated their theoretical alcohol knowledge higher than their practical knowledge (η² = 0.33, p < 0.001). Higher reported levels of practical knowledge were associated with higher intervention frequency (b = 0.39, β = 0.60, p < 0.001) and greater likelihood of conducting individual interventions (OR = 1.60, p < .001) as well as group interventions (OR = 1.84, p < 0.001). Theoretical knowledge was not associated with conducting interventions, and there was no evidence of an interaction between the two ways of knowing in their association with doing. Sensitivity analyses did not indicate clustering effects of OHS personnel being employed within different units.

CONCLUSIONS

Different ways of knowing about alcohol among OHS personnel were dissimilarly associated with conducting alcohol prevention interventions in occupational health settings. For doing, knowing how seems to be more important than knowing that. Training programs for OHS personnel should emphasize knowledge about how to deal with alcohol-related issues and how to conduct prevention interventions, rather than focus on detrimental effects of alcohol.

Do health professionals' attitudes towards alcohol use matter for alcohol prevention efforts? Results from the WIRUS-OHS study

BACKGROUND

Use of alcohol is a major public health issue, representing the 7^th largest burden of disease in the world. Workplaces offer a unique arena for health initiatives addressing alcohol use, where occupational health services (OHS) personnel play an important role. However, we do not know if the extent of such initiatives may be influenced by personal drinking attitudes among OHS personnel. Thus, the aim of the study was to explore how drinking attitudes among OHS personnel were associated with their frequency of working with alcohol-related cases and with their views on alcohol prevention activities in the OHS.

METHODS

The WIRUS project included a cross-sectional survey of attitudes and practices among OHS personnel (n = 325) employed by Norwegian OHS services (n = 69), who informed about sociodemographic and professional characteristics, drinking attitudes, frequency of cases with alcohol-related issues, and perceptions toward the role of the OHS in primary, secondary, and tertiary alcohol prevention activities. Measures of associations were examined with linear and logistic regression models.

RESULTS

Drinking attitudes were unrelated to the frequency of working with alcohol-related cases. Physicians, psychologists, and nurses had higher frequency of working with alcohol-related cases, compared to those with other professional backgrounds (β = 0.46, p = 0.01). Drinking attitudes were also unrelated to attitudes towards primary/secondary/tertiary alcohol prevention activities in the OHS, while female OHS personnel were more positive towards increased primary alcohol prevention activities in the OHS (OR: 1.82, p < 0.05). Only marginal portions (1%-3%) of the variance in attitudes towards alcohol prevention activities in the OHS were accounted for by the models.

CONCLUSION

This study did not find evidence of associations between OHS personnel's drinking attitudes and their practices and attitudes towards alcohol prevention activities. The lack of association between OHS personnel's attitudes towards alcohol use and their attitudes and practices relating to alcohol prevention in the workplace might point towards professionalism, as personal attitudes appear not to interfere with their priorities and professional mission. Given the small amount of outcome variance explained by the tested models, other variables should be used in future studies.

Association between self-reported binge drinking and absenteeism in the Baltic countries

Objective

Substantial loss of productivity due to absenteeism is associated with alcohol use. This study examined the associations between absenteeism in the workplace and in schools and binge drinking across various beverage types in the Baltic countries.

Methods

We utilised a dataset of 3,778 individuals compiled from 2015 to 2016 and performed multiple negative binomial regression analysis with multiple imputations to deal with missing data. Self-reported measures were used for both absenteeism and binge drinking.

Results

We found evidence to support the claim that absenteeism, in terms of self-reported absence days, is positively associated with self-reported binge drinking, specifically with beer bingeing. On average, beer bingers reported 49% (p < .05) more absences than people who drink alcohol but do not binge on beer. For wine and spirits variables, the estimates indicated positive but statistically insignificant associations. No group differences were identified across gender and education.

Conclusions

A considerable proportion of days absent from work and from school can be associated with beer bingeing. Therefore, it should be acknowledged that beverage-specific alcohol policies that are more lenient toward beer than other types of alcohol can inadvertently increase absenteeism and decrease workplace productivity.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

AIM

Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term).

METHOD

Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078.

RESULTS

Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60).

CONCLUSION

This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

Prevalence of and factors associated with long-term sick leave in working-age adults with chronic low back pain in Germany

OBJECTIVE

There are little data on the impact of chronic low back pain (CLBP) on long-term sick leave. Thus, the aim was to investigate the prevalence of and the factors associated with long-term sick leave in working-age adults with CLBP in Germany.

METHODS

This retrospective study included adults aged 18-65 years diagnosed for the first time with CLBP in one of 1193 general practices in Germany between 2000 and 2019. CLBP was defined as the presence of two diagnoses of low back pain with > 90 days between them. Long-term sick leave was assessed in the year following the first diagnosis of low back pain, and was defined as > 42 days of absence from work for health-related reasons. In Germany, employees on sick leave lasting > 42 days are not paid by the employer anymore but by the health insurance fund. Finally, an adjusted logistic regression model was used to assess the association between predefined variables (e.g., age, sex, and comorbidities) and long-term sick leave.

RESULTS

A total of 59,269 working-age adults were included in this study [mean (SD) age 32.8 (11.5) years; 41.4% women]. The prevalence of long-term sick leave in the sample was 49.1%. Long-term sick leave was significantly associated with young age, male sex, and several physical and psychiatric comorbidities (e.g., reaction to severe stress and adjustment disorder, gastritis and duodenitis, and depression).

CONCLUSIONS

Based on these results, public health measures are urgently needed to mitigate the deleterious effects of CLBP on work participation in Germany.

Willingness to Participate in Alcohol Prevention Interventions Targeting Risky Drinking Employees. The WIRUS Project

Background: The extent to which eligible individuals in a target population are willing to participate in interventions is important when evaluating the efficacy of public health interventions.

Objectives: As part of a process evaluation of an ongoing randomized controlled trial, this study aimed to identify the proportion of risky drinkers who were willing to participate in an alcohol prevention intervention in an occupational health setting, and correlates for such willingness.

Methods: Risky drinking employees from 22 companies in Norway were identified through an alcohol screening survey. Risky drinkers' (N = 779) willingness to complete a health examination and to be randomized into an alcohol prevention intervention (digital or face-to-face intervention, or control) was recorded by personnel from occupational health services. The proportion of employees who were willing to participate was assessed on 31 potential correlates (sociodemographic, alcohol-related, work-related, and lifestyle/daily activity). Adjusted (multiple logistic regression) analyses were utilized to explore associations between potential correlates and willingness to participate.

Results: Altogether, 38.1% of employees were willing to participate in prevention interventions. In the adjusted analysis, only 5 out of 31 potential correlates were significantly associated with willingness to participate. Managers were more than twice as willing to participate than workers (OR = 2.17, p < 0.01). Willing employees had less workplace decision latitude (perceived control over workplace decisions and less possibility of utilizing personal skills in the job) (OR = 0.62, p < 0.05), and were more overcommitted with exorbitant work ambition and need for approval (OR = 1.49, p < 0.05). Willing employees had to some extent less alcohol-related impaired work performance (presenteeism, OR = 0.78, p < 0.05), and they spent less time on care activities (OR = 0.84, p < 0.05).

Conclusions: Reaching four out of ten with risky drinking habits for prevention interventions strengthens the rationale for targeting this public health problem in occupational health care settings. In particular, this study suggests the importance of ensuring secure commitment among workers, who were less willing til participate than managers. Nevertheless, tailoring recruitment and implementation strategies based on easily identifiable correlates may be onerous.